Decompression ng suprascapular nerve

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview¶

Indications and Treatment Strategy¶

• Initial treatment of isolated suprascapular neuropathy is typically nonoperative, consisting of physical therapy, nonsteroidal anti-inflammatory drugs, and activity modification [21].
• Open or arthroscopic operative intervention is warranted when there is extrinsic nerve compression or progressive pain and/or weakness [21].
• In the absence of a well-defined lesion producing mechanical compression of the suprascapular nerve, suprascapular neuropathy should be treated non-operatively [10].
• Suprascapular neuropathy treated with SSND significantly improves patient-reported outcomes and is noninferior to similar procedures without SSND [6].
• Surgical decompression in the setting of suprascapular neuropathy leads to satisfactory outcomes as evidenced by the patient-reported outcomes and return to sport rate [2].

Outcomes¶

• Arthroscopic SSN decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery [7].
• Outcomes after arthroscopic suprascapular nerve release at the suprascapular notch predictably led to successful pain relief and strength improvement in patients presenting with pain and weakness respectively [13].
• Arthroscopic release of the suprascapular nerve can be performed safely and effectively, with all patients showing improvement in postoperative electromyographic findings and marked improvement in pain relief and function [15].
• Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain and a return of normal shoulder function [9].
• Treatment of choice for suprascapular nerve entrapment at the spinoglenoid notch caused by a ganglion cyst is surgical decompression by complete excision of the ganglion along with its pedicle, even though full recovery of the nerve may not be expected in each case [11].

Concomitant Rotator Cuff Pathology¶

• Suprascapular nerve release does not seem to be justified as an adjunct to RC repair if preoperative EMG findings document normal suprascapular nerve function [16].
• Decompression of the suprascapular nerve at the spinoglenoid notch did not lead to a better functional outcome compared to repair alone in patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy [12].
• Combined arthroscopic release of the superior transverse scapular ligament and rotator cuff repair in patients with large/massive RCTs and suprascapular neuropathy did not produce statistically significant improved outcomes compared with repair of the rotator cuff alone [45].
• Additional suprascapular nerve release did not provide additional benefit in arthroscopic rotator cuff repair surgery [94].
• No recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time, and further research is necessary to better delineate the indications in the future [3].

Surgical Techniques and Safety¶

• Arthroscopic decompression of the suprascapular nerve provides excellent visualization and the ability to address concomitant shoulder pathology [1].
• Arthroscopic release of the suprascapular nerve is a less invasive and potentially more effective way to treat suprascapular neuropathy [8].
• A novel arthroscopic technique for suprascapular nerve decompression uses the superior border of the scapula as a guide, potentially reducing operative time and tissue removal compared to previous methods [5].
• The superior trapezius splitting approach allows a safe, direct and relatively simple approach to decompression of the suprascapular nerve [17].
• The anterior release of the suprascapular nerve is a feasible alternative to the lateral approach [19].
• The suprascapular artery must be identified and protected along with the nerve during decompression to ensure safety [22].

Pathology and Diagnosis¶

• Suprascapular neuropathy with complete neurogenic fatty replacement can occur in patients with intact rotator cuff tendons in the absence of traction or compression mechanisms [4].
• Twenty-eight patients with suprascapular nerve entrapment confirmed by electromyographic and nerve conduction studies were identified and treated [18].

Anatomy & Pathophysiology¶

Nerve Course and Entrapment Sites¶

• The suprascapular nerve originates from the upper trunk of the brachial plexus and courses to its motor insertion on the supraspinatus and, more distally, the infraspinatus [29].
• At the suprascapular notch, the suprascapular nerve runs deep to the superior transverse scapular ligament, while the suprascapular artery runs superior to the ligament [55].
• At the spinoglenoid notch, both the suprascapular artery and nerve pass inferior to the inferior transverse scapular ligament [66].
• The spinoglenoid ligament overlies the suprascapular nerve at the spinoglenoid notch [55].
• Entrapment of the suprascapular nerve at the suprascapular notch causes denervation of both the supraspinatus and infraspinatus muscles [55].
• Entrapment, traction, or compression of the suprascapular nerve at the spinoglenoid notch causes denervation of the infraspinatus muscle [55].
• The inferior transverse scapular ligament was present in 33 of 40 shoulders (82.5%) in an anatomical study [85].
• In 52 of 60 shoulders, the suprascapular artery was located on the transverse ligament and positioned superiolaterally [87].
• Anatomical variations at the suprascapular notch, including abnormally oriented subscapularis muscle fibers, anterior coracoscapular ligament, and calcified superior transverse scapular ligament, are predisposing factors for suprascapular nerve entrapment [33].
• The suprascapular nerve has limited translational freedom at the suprascapular notch as it angles around the confined space of the notch [25].
• The angled pathway and limited mobility of the nerve at the suprascapular notch predispose it to mechanical stretching, which may be exacerbated by extreme positions of scapular depression, retraction, or abduction [25].
• During cross-body adduction and internal rotation of the glenohumeral joint, the interaction of the spinoglenoid ligament and the posterior capsule results in a tightening of the spinoglenoid ligament [86].
• Secondary to the spinoglenoid ligament's attachment to the posterior capsule, horizontal adduction and internal rotation of the shoulder places tension on the ligament, entrapping the suprascapular nerve under it in the lateral corner of the tunnel [84].

Etiology and Mechanisms of Injury¶

• Suprascapular neuropathy can occur as a result of traction, direct trauma, extrinsic compression, or as part of a more generalized brachial plexus disorder [25].
• Traction of the suprascapular nerve can occur at the suprascapular or spinoglenoid notch secondary to repetitive microtrauma from overhead activities such as tennis, volleyball, and weight lifting [25].
• Repetitive microtrauma may lead to direct injury to the nerve or indirect injury by affecting the vascular supply to the nerve [25].
• Intimal damage to the axillary or suprascapular artery may lead to microemboli that become trapped in the vasa nervorum, leading to ischemic injury to the suprascapular nerve [25].
• Direct or indirect trauma during glenohumeral dislocation, proximal humerus fracture, or scapular fracture may result in suprascapular neuropathy [25].
• Iatrogenic injury to the suprascapular nerve has been reported as a consequence of distal clavicle resection, positioning during spine surgery, transglenoid arthroscopic anterior shoulder stabilization, shoulder arthrodesis, or procedures utilizing the posterior approach to the shoulder [25].
• Repetitive microtrauma or a single traumatic event is more likely to cause suprascapular neuropathy at the level of the suprascapular notch [25].
• Compression by a ganglion cyst or tumor is a cause of suprascapular neuropathy, particularly at the level of the spinoglenoid notch [25].
• Cystic lesions arising from a labral or capsular tear can compress the nerve along its course over the scapula [29].
• Nerve traction is theorized to arise from chronic overhead athletics or due to a retracted rotator cuff tear [29].
• The exact association and etiology of suprascapular neuropathy in patients with rotator cuff pathology remain unclear [28].
• The suprascapular nerve can be damaged during muscle advancement in two phases: detachment of the supraspinatus muscle from the supraspinatus fossa and excessive tension applied when shifting the muscle laterally [14].
• Suprascapular nerve entrapment can occur secondary to a lipoma [27].
• Suprascapular nerve entrapment can occur secondary to a large hematoma of the scapula [35].
• Suprascapular nerve entrapment can occur secondary to a schwannoma [36].
• Independent suprascapular notch entrapment can coexist with a spinoglenoid notch cyst [34].

Clinical Presentation and Pathological Consequences¶

• The most common and consistent presenting symptom of suprascapular nerve entrapment related to sport is shoulder pain, with almost always wasting and atrophy of the supra and infraspinatus musculature [20].
• Entrapment of the suprascapular nerve at the suprascapular notch is a cause of shoulder pathology that should be considered in people presenting with wasting of the supraspinatus or infraspinatus muscles, or both [49].
• Suprascapular neuropathy is a potential source of shoulder pain and functional limitation [29].
• The incidence of compressive suprascapular neuropathy is quite high in the overhead athletic cohort, but most patients do not show clinically relevant deficiencies in function [29].
• An unexpected humeral head shift following suprascapular nerve entrapment can lead to proprioception disturbance and cause functional instability if the coordinated and conditioned muscles were not functioning very well [81].
• A reduction of 33% or more of external rotation power compared with internal rotation power, or a reduction of 33% or more of external rotation power compared with supraspinatus power as assessed by handheld dynamometry, is predictive for the diagnosis of a superior glenoid labrum cyst with suprascapular nerve entrapment [80].

Classification¶

Etiology and Mechanism¶

• Suprascapular neuropathy can occur as a result of traction, direct trauma, or extrinsic compression [25].
• Suprascapular neuropathy can also occur as part of a more generalized brachial plexus disorder [25].
• Direct trauma or indirect trauma during glenohumeral dislocation, proximal humerus fracture, or scapular fracture may result in suprascapular neuropathy [25].
• At the suprascapular notch, the nerve has little translational freedom as it angles around the confined space of the notch [25].
• The angled pathway and limited mobility at the suprascapular notch predispose the nerve to mechanical stretching, which may be exacerbated by extreme positions of scapular depression, retraction, or abduction [25].
• A variety of potential causes of compression include anomalous transverse scapular ligaments, ganglion cysts, abnormal bony morphology, direct trauma, and traction injury [24].
• An intraosseous ganglion of the glenoid invading adjacent soft tissue can cause suprascapular nerve entrapment syndrome [32].
• A lipoma can cause suprascapular nerve entrapment [27].

Clinical Presentation¶

• The most common and consistent presenting symptom of suprascapular nerve entrapment related to sport is shoulder pain [20].
• Suprascapular nerve entrapment related to sport is almost always associated with wasting and atrophy of the supra and infraspinatus musculature [20].
• Patients with suprascapular nerve neuropathy usually complain of a dull, aching pain in the posterior and lateral aspects of the shoulder [24].
• When the nerve is entrapped at the suprascapular notch, patients present with weakness and atrophy of both the supraspinatus and infraspinatus [24].
• With entrapment at the spinoglenoid notch, symptoms of weakness and atrophy are isolated to the infraspinatus [24].
• Suprascapular neuropathy is a potential source of shoulder pain and functional limitation that can present secondary to various etiologies including entrapment or compression [29].

Diagnostic Evaluation¶

• The diagnosis of suprascapular neuropathy is based on a combination of a detailed history, a comprehensive physical examination, imaging, and electrodiagnostic studies [29].
• A detailed history and physical examination along with appropriate workup are paramount to arrive at a diagnosis of suprascapular nerve entrapment [24].
• Twenty-eight patients with suprascapular nerve entrapment were identified and treated based on confirmation by electromyographic and nerve conduction studies [18].
• A complete history and physical, careful attention to auxiliary tests, and treatment of multiple diagnoses in the same shoulder avoids missed pathologic features and necessity for revision operations [27].
• In 12% of patients with rotator cuff tears, a massive tear was identified that was associated with moderate to severe fatty muscle atrophy of the supraspinatus and infraspinatus muscles [47].
• Of patients with massive rotator cuff tears, 54% were identified to have a peripheral nerve injury by electrodiagnostic study [47].
• Electromyographic scores were abnormal for both the supraspinatus and infraspinatus in all patients with isolated suprascapular nerve injury [47].
• The supraspinatus electromyographic score was grade 1 in all patients with isolated suprascapular nerve injury [47].
• The infraspinatus electromyographic score was grade 2 in 3 patients and grade 1 in the remaining 3 patients with isolated suprascapular nerve injury [47].

Indications for Treatment¶

• Surgical decompression is indicated in cases refractory to conservative management [24].
• Surgical release is not routinely recommended unless patients with pain or deficits in strength fail appropriate nonsurgical treatment [29].
• Treatment of choice for suprascapular nerve entrapment caused by a ganglion cyst is surgical decompression by complete excision of the ganglion along with its pedicle [11].
• Full recovery of the nerve may not be expected in each case following treatment of ganglion cysts [11].
• Suprascapular nerve release does not seem to be justified as an adjunct to rotator cuff repair if preoperative EMG findings document normal suprascapular nerve function [16].
• No recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time [3].
• Further research is necessary to better delineate the indications for suprascapular nerve release in conjunction with rotator cuff repair [3].

Clinical Presentation¶

Symptoms and Signs¶

• The most common and consistent presenting symptom of suprascapular nerve entrapment is shoulder pain [20].
• Patients with suprascapular nerve entrapment typically present with wasting and atrophy of the supraspinatus and infraspinatus musculature [20].
• Patients with suprascapular neuropathy usually complain of a dull, aching pain in the posterior and lateral aspects of the shoulder [24].
• Patients with suprascapular entrapment complain primarily of deep burning or aching pain in the posterior and lateral aspect of the shoulder [38].
• Weakness of external rotation follows suprascapular nerve entrapment [38].
• Atrophy of the supraspinous and infraspinous muscles follows suprascapular nerve entrapment [38].
• All shoulder motion may be painful initially in suprascapular nerve entrapment, but within a few weeks only external rotation is limited unless a frozen shoulder develops [38].
• Suprascapular nerve entrapment at the spinoglenoid notch leads to weakness and atrophy of the infraspinatus [24].
• Entrapment of the suprascapular nerve at the suprascapular notch presents with weakness and atrophy of both the supraspinatus and infraspinatus [24].
• Entrapment of the suprascapular nerve at the spinoglenoid notch presents with symptoms isolated to the infraspinatus [24].
• Suprascapular nerve entrapment at the suprascapular notch is a cause of shoulder pathology that should be considered in people presenting with wasting of the supraspinatus or infraspinatus muscles, or both [49].
• Suprascapular neuropathy can present with pain and weakness [13].

Etiology and Mechanisms¶

• Suprascapular neuropathy can occur as part of a more generalized brachial plexus disorder [25].
• Repetitive microtrauma may lead to direct injury to the suprascapular nerve or indirect injury by affecting the vascular supply to the nerve [25].
• A variety of potential causes of compression for suprascapular nerve entrapment include anomalous transverse scapular ligaments, ganglion cysts, abnormal bony morphology, direct trauma, and traction injury [24].
• Cystic lesions arising from a labral or capsular tear can compress the suprascapular nerve along its course over the scapula [29].
• A schwannoma of the suprascapular nerve can cause symptoms that resolve with careful surgical excision [36].
• Bilateral suprascapular nerve entrapment syndrome associated with rotator cuff tear is a rare condition [43].

Diagnosis¶

• The key to diagnosis of suprascapular nerve entrapment is electrodiagnostic evaluation [38].
• Electromyography demonstrates denervation of the supraspinous and infraspinous muscles in suprascapular nerve entrapment [38].
• There is increased motor latency of the suprascapular nerve across the transverse scapular ligament in suprascapular nerve entrapment [38].
• Shoulder surgeons should consider electrophysiologic evaluation of patients with clinical or radiographic signs of suprascapular neuropathy [37].
• Suprascapular nerve entrapment confirmed by electromyographic and nerve conduction studies has been identified in twenty-eight patients [18].

Investigations¶

Electrophysiology¶

• Electromyographic and nerve conduction studies are used to confirm the diagnosis of suprascapular nerve entrapment [18].
• Shoulder surgeons should consider electrophysiologic evaluation for patients with clinical or radiographic signs of suprascapular neuropathy and be cognizant of the parameters that constitute an abnormal study [37].
• Preoperative electromyography findings documenting normal suprascapular nerve function indicate that suprascapular nerve release is not justified as an adjunct to rotator cuff repair [16].
• Arthroscopic release of the suprascapular nerve results in improvement of postoperative electromyographic findings [15].

Imaging¶

• Magnetic resonance imaging and electromyography can demonstrate a subacute muscle denervation pattern indicating the suprascapular nerve as the most probable site of compression [31].
• MRI can identify labral tears and rotator cuff tears, although accuracy for these is enhanced by combining the scan with arthrography [69].
• MRI is the modality of choice for evaluating the rotator cuff, biceps, and subacromial/subdeltoid bursa [76].
• T2-weighted MRI provides better visualization of full-thickness rotator cuff tears [76].
• MR arthrography is considered the benchmark for evaluation of labral tears and is rarely indicated for evaluation of rotator cuff pathology [76].
• Ultrasonography is a low-cost alternative to MRI and arthrography for evaluating both skeletal and soft-tissue structures of the shoulder [76].
• Ultrasonography can provide immediate, real-time visualization of the rotator cuff, biceps tendon, and calcific deposits [76].
• Ultrasonography can be used to detect atrophy of rotator cuff muscles [76].
• Ultrasonography is highly operator dependent and is not as useful for evaluating labral tears or rotator cuff tears that are very small or larger than 3 cm [76].
• CT imaging is frequently used to evaluate fractures of the shoulder, to assess for bony lesions in recurrent instability cases, or for preoperative templating for shoulder arthritis [76].
• The purpose of imaging of the shoulder is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition of the shoulder to the patient [42].
• Standardized plain films are almost always sufficient to garner the information needed for shoulder evaluation [42].
• The axillary view taken with the arm in the functional position of elevation in the plane of the scapula is referred to as the "truth view" because it demonstrates the glenohumeral relationships in the functional position of elevation [42].
• The axillary view enables visualization of both the spinoglenoid notch and the scapular neck [42].
• CT scans have the disadvantage of being taken with the arm in the adducted position, unlike the axillary truth view which is taken in elevation [42].
• Three-dimensional reconstructions can reveal fine details of the shoulder anatomy, but this additional information rarely changes the planning or conduct of the arthroplasty [42].
• The temptation to "overimage" should be resisted, obtaining only the scans or reconstructions that are necessary for the care of the patient [42].

Treatment¶

Non-Operative Management¶

Operative Indications¶

• Treatment of choice for suprascapular nerve entrapment at the spinoglenoid notch caused by a ganglion cyst is surgical decompression by complete excision of the ganglion along with its pedicle [11].

Surgical Techniques¶

• A hybrid endoscopic technique for the release of the transverse scapular ligament is described as a novel, safe, effective, and facile approach for decompression of the suprascapular nerve at the suprascapular notch [31].
• Arthroscopic release of the superior transverse ligament is an effective procedure for decompression of the suprascapular nerve [39].
• Open decompression of the suprascapular nerve at the spinoglenoid notch permits direct visualization of the nerve and allows for a safe, reliable, and thorough decompression [24].
• For open spinoglenoid notch decompression, the patient is placed in the lateral decubitus position with the head elevated 30° and the body over-rotated 10° to 20° past parallel anteriorly [93].
• In open spinoglenoid notch decompression, the deltoid is split in line with its fibers beginning approximately 4 to 5 cm from the posterolateral corner of the acromion [93].
• The spinoglenoid ligament is released sharply from the edge of the scapular spine during open decompression [93].

Outcomes and Efficacy¶

• Surgical decompression in the setting of suprascapular neuropathy leads to satisfactory outcomes as evidenced by patient-reported outcomes and return to sport rate [2].
• Suprascapular neuropathy treated with suprascapular nerve decompression significantly improves patient-reported outcomes and is noninferior to similar procedures without decompression [6].
• Arthroscopic suprascapular nerve decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery [7].
• Arthroscopic management of suprascapular neuropathy provides patients with significant improvements in pain, strength, and subjective function of the shoulder, and has a low incidence of complications [23].

Concomitant Pathology and Adjuncts¶

Safety and Complications¶

• Careful preoperative planning, proper surgical methodology and technique are essential in minimizing surgical complications [51].

Complications¶

Iatrogenic Injury During Suprascapular Nerve Decompression¶

• Ultrasound-assisted intralesional methylene blue injection may facilitate uneventful decompression of symptomatic spinoglenoid notch cysts while preventing iatrogenic suprascapular nerve injury [95].

Iatrogenic Injury From Other Shoulder Procedures¶

• Iatrogenic injury to the suprascapular nerve has been reported as a consequence related to distal clavicle resection, positioning during spine surgery, transglenoid arthroscopic anterior shoulder stabilization, shoulder arthrodesis, or procedures utilizing the posterior approach to the shoulder, such as posterior shoulder stabilization [25].
• A malpositioned superior screw from reverse shoulder arthroplasty can cause suprascapular nerve entrapment [40].
• Iatrogenic suprascapular neuropathy can occur secondary to drilling for superior labrum anterior-posterior repair [51].
• Careful preoperative planning, proper surgical methodology and technique are essential in minimizing surgical complications during drilling for superior labrum anterior-posterior repair [51].

Complications Associated With Concomitant Pathology¶

• Suprascapular nerve release might not be routinely needed in rotator cuff tendon repair as no additional benefits in functional improvement or pain relief were identified compared to rotator cuff tendon repair alone [96].

General Complication Rates¶

• Arthroscopic management of suprascapular neuropathy has a low incidence of complications [23].

Recovery¶

• Suprascapular neuropathy treated with suprascapular nerve decompression significantly improves patient-reported outcomes and is noninferior to similar procedures without suprascapular nerve decompression [6].
• Treatment of choice for suprascapular nerve entrapment caused by a ganglion cyst is surgical decompression by complete excision of the ganglion along with its pedicle, even though full recovery of the nerve may not be expected in each case [11].
• Full recovery of shoulder function was achieved in a case report of suprascapular nerve entrapment caused by a large hematoma of the scapula [35].
• With careful surgical excision of a schwannoma of the suprascapular nerve, patients can expect symptom resolution and restoration of shoulder function [36].

Key Evidence¶

• [L5] Arthroscopic decompression of the suprascapular nerve provides excellent visualization and the ability to address concomitant shoulder pathology. [1] (10.1016/j.jse.2010.01.006)
• [L4] Surgical decompression in the setting of suprascapular neuropathy leads to satisfactory outcomes as evidenced by the patient-reported outcomes and return to sport rate. [2] (10.1016/j.jse.2017.09.025)
• [L4] No recommendations regarding suprascapular nerve release in conjunction with rotator cuff repair can be made at this time, and further research is necessary to better delineate the indications in the future. [3] (10.1016/j.jse.2011.11.033)
• [L4] This is the first description of suprascapular neuropathy with complete neurogenic fatty replacement in patients with intact rotator cuff tendons in the absence of traction or compression mechanisms. [4] (10.1016/j.arthro.2014.01.010)
• [L4] The study describes a novel arthroscopic technique for suprascapular nerve decompression that uses the superior border of the scapula as a guide, potentially reducing operative time and tissue removal compared to previous methods. [5] (10.1007/s00167-009-0858-1)
• [L4] Suprascapular neuropathy treated with SSND significantly improves patient-reported outcomes and is noninferior to similar procedures without SSND. [6] (10.1016/j.xrrt.2024.05.007)
• [L4] Arthroscopic SSN decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant glenohumeral pathology results in good functional outcomes with significant improvements from before to after surgery. [7] (10.1016/j.arthro.2020.10.020)
• [L4] Arthroscopic release of the suprascapular nerve is a less invasive and potentially more effective way to treat suprascapular neuropathy. [8] (10.1097/00132589-200606000-00004)
• [L4] Release of the spinoglenoid ligament with resultant suprascapular nerve decompression may result in relief of pain and a return of normal shoulder function. [9] (10.1177/03635465990270062101)
• [L4] In the absence of a well-defined lesion producing mechanical compression of the suprascapular nerve, suprascapular neuropathy should be treated non-operatively. [10] (10.2106/00004623-199708000-00007)
• [L5] Treatment of choice is surgical decompression of the suprascapular nerve by complete excision of the ganglion along with its pedicle, even though full recovery of the nerve may not be expected in each case. [11] (10.1016/s1058-2746(96)80011-5)
• [L3] Decompression of the suprascapular nerve at the spinoglenoid notch did not lead to a better functional outcome compared to repair alone in patients with posterosuperior massive rotator cuff tears and suprascapular neuropathy. [12] (10.1186/s12891-021-04075-1)
• [L4] Outcomes after arthroscopic suprascapular nerve release at the suprascapular notch predictably led to successful pain relief and strength improvement in patients presenting with pain and weakness respectively. [13] (10.1177/2325967123s00003)
• [L5] The suprascapular nerve can be damaged during muscle advancement in two phases: detachment of the supraspinatus muscle from the supraspinatus fossa and excessive tension applied when shifting the muscle laterally. [14] (10.1016/s1058-2746(02)00034-4)
• [L4] Arthroscopic release of the suprascapular nerve can be performed safely and effectively, with all patients showing improvement in postoperative electromyographic findings and marked improvement in pain relief and function. [15] (10.1016/j.arthro.2006.10.003)
• [L2] Suprascapular nerve release does not therefore seem to be justified as an adjunct to RC repair if preoperative EMG findings document normal suprascapular nerve function. [16] (10.1016/j.jse.2020.03.051)
• [L4] The superior trapezius splitting approach allows a safe, direct and relatively simple approach to decompression of the suprascapular nerve. [17] (10.1016/s1058-2746(96)80262-x)
• [L4] Twenty-eight patients with suprascapular nerve entrapment confirmed by electromyographic and nerve conduction studies were identified and treated. [18] (10.1016/1058-2746(93)90062-l)
• [L5] The anterior release of the suprascapular nerve is a feasible alternative to the lateral approach. [19] (10.1016/j.eats.2024.103237)
• [L4] The most common and consistent presenting symptom is shoulder pain, with almost always wasting and atrophy of the supra and infraspinatus musculature. [20] (10.1016/s1058-2746(95)80144-8)
• [L5] Initial treatment of isolated suprascapular neuropathy is typically nonoperative, consisting of physical therapy, nonsteroidal anti-inflammatory drugs, and activity modification; however, open or arthroscopic operative intervention is warranted when there is extrinsic nerve compression or progressive pain and/or weakness. [21] (10.2106/jbjs.i.01743)
• [L4] The authors emphasize that the suprascapular artery must be identified and protected along with the nerve during decompression to ensure safety. [22] (10.1016/j.jse.2008.08.007)
• [L4] Results indicate that arthroscopic management provides patients with significant improvements in pain, strength, and subjective function of the shoulder, and has a low incidence of complications. [23] (10.1007/s00167-017-4694-4)
• [L5] [24] (10.1016/j.eats.2024.103051)
• [L5] [25] (10.5435/00124635-199911000-00002)
• [L4] A complete history and physical, careful attention to auxiliary tests, and treatment of multiple diagnoses in the same shoulder avoids missed pathologic features and necessity for revision operations. [27] (10.1097/01.blo.0000063791.32430.59)
• [L3] The exact association and etiology of suprascapular neuropathy in patients with rotator cuff pathology remain unclear. [28] (10.1016/j.jse.2013.06.011)
• [L5] [29] (10.5435/jaaos-d-19-00526)
• [L5] [31] (10.1097/bte.0000000000000183)
• [Case_report] This is the first report of an intraosseous ganglion of the glenoid invading adjacent soft tissue to cause suprascapular nerve entrapment syndrome, which showed clinical and radiologic improvement after needle aspiration. [32] (10.1016/j.jse.2008.10.014)
• [L4] Anatomical variations at the suprascapular notch, including abnormally oriented subscapularis muscle fibers, anterior coracoscapular ligament, and calcified superior transverse scapular ligament, are predisposing factors for suprascapular nerve entrapment. [33] (10.1007/s00167-003-0378-3)
• [L5] [34] (10.1016/j.xrrt.2026.100879)
• [Case_report] Full recovery of shoulder function was achieved. [35] (10.1186/s12891-023-06723-0)
• [L5] With careful surgical excision, patients can expect symptom resolution and restoration of shoulder function. [36] (10.1016/j.jse.2005.02.005)
• [L4] Shoulder surgeons should consider electrophysiologic evaluation of patients with clinical or radiographic signs of suprascapular neuropathy and be cognizant of the parameters that constitute an abnormal study. [37] (10.1016/j.jse.2010.10.039)
• [L5] [38] (10.1016/s0363-5023(82)80015-4)
• [Case_report] Arthroscopic release of the superior transverse ligament is an effective procedure for decompression of the suprascapular nerve. [39] (10.1016/j.arthro.2006.07.033)
• [Case_report] This case is the first report of malpositioned superior screw from reverse shoulder arthroplasty causing suprascapular nerve entrapment. [40] (10.1016/j.jse.2009.10.004)
• [L5] Bilateral suprascapular nerve entrapment syndrome associated with rotator cuff tear is a rare condition that can lead to correct early diagnosis through awareness of its clinical presentation. [43] (10.1016/s1058-2746(00)90013-2)
• [L1] Combined arthroscopic release of the superior transverse scapular ligament and rotator cuff repair in patients with large/massive RCTs and suprascapular neuropathy did not produce statistically significant improved outcomes compared with repair of the rotator cuff alone. [45] (10.1177/03635465211021834)
• [L4] [47] (10.1016/j.arthro.2007.06.014)
• [L5] Entrapment of the SSN at the suprascapular notch is a cause of shoulder pathology that should be considered in people presenting with wasting of the supraspinatus or infraspinatus muscles, or both. [49] (10.1016/j.jse.2010.12.003)
• [Case_report] [51] (10.1016/j.jisako.2026.101083)
• [L4] The most predictive tests for the diagnosis of a GLEN lesion were a reduction of 33% or more of external rotation power compared with internal rotation power, or a reduction of 33% or more of external rotation power compared with supraspinatus power as assessed by handheld dynamometry. [80] (10.1097/01.bte.0000170070.67295.a4)
• [L5] The unexpected humeral head shift can lead to proprioception disturbance and cause functional instability if the coordinated and conditioned muscles were not functioning very well. [81] (10.1016/s1058-2746(96)80261-8)
• [L5] Secondary to the SGL's attachment to the posterior capsule of the shoulder, as horizontal adduction and internal rotation of the shoulder occurs, tension on the SGL entraps the SSN under it in the lateral corner of the tunnel. [84] (10.1016/s1058-2746(96)80481-2)
• [L5] The inferior transverse scapular ligament was present in 33 shoulders (82.5%). [85] (10.1016/s1058-2746(98)90161-6)
• [L5] During cross-body adduction and internal rotation of the glenohumeral joint, the interaction of the SGL and the posterior capsule resulted in a tightening of the SGL. [86] (10.1016/s1058-2746(98)90051-9)
• [Paper] In fifty two of sixty shoulders, the suprascapular artery was on the transverse ligament and located on superiolaterally. [87] (10.1016/s1058-2746(96)80257-6)
• [L4] [93] (10.1016/j.jse.2013.03.009)
• [L1] The result of this study showed that additional suprascapular nerve release did not provide additional benefit in arthroscopic rotator cuff repair surgery. [94] (10.1007/s00167-022-07066-4)
• [L4] We believe that this technique may facilitate uneventful decompression of symptomatic spinoglenoid notch cysts while preventing iatrogenic suprascapular nerve injury. [95] (10.1016/j.jse.2021.03.076)
• [L1] The present meta-analysis revealed that SSNR might not be routinely needed in rotator cuff tendon repair as no additional benefits in functional improvement or pain relief were identified compared to rotator cuff tendon repair alone. [96] (10.1016/j.jse.2022.05.015)

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